What is Cognitive Behavior Therapy?
Cognitive Behavior Therapy, or CBT for short, is a specific type of psychotherapy that is focused on helping people learn new thinking patterns that help them change their emotional states. People who have been treated with CBT usually find that they have symptom relief very early in the therapy process and they tend to find that they can maintain these gains over their lives. They also find that they tend to only need a brief amount of therapy sessions (usually from 5-15 sessions) to achieve their therapeutic goals
CBT is an active therapy that expects a cooperative working relationship between therapist and client (and sometimes family members as well). Clients are taught that they do have control over their emotions and moods and the relationship between the way they think and how they feel. Negative thoughts are confronted and re-evaluated so that the client can actively work towards eliminating first the cause of their emotional problem, then, the problem itself.
Our CBT therapists have worked with hundreds of clients and have had great success with these set of techniques. Many clients have entered treatment with us after years of psychoanalysis or other types of therapy that just did not work for them. After working with them using CBT therapy, they found a new way to deal with their problem and started to feel better- at times, for the first time in many, many years.
Don't just take our word for it- the recent literature and government reviews are chocked full of support for this technique and its efficacy in helping people with anxiety, panic and depression. The following article discusses how brain mapping may be able to show how CBT effects brain function....
Depression
FOR almost a century after Sigmund Freud pioneered psychoanalysis, “talk therapy” was the treatment of choice for many mental illnesses. Artists and writers lined up to lie down and be analyzed, and the ideas of Freud, Jung, and other influential psychiatrists permeated the intellectual world. They also seeped into the popular consciousness, and still pop up today whenever someone talks of a subconscious desire, a Freudian slip, a death wish, or an Oedipal complex. But advances in neurology, and especially in pharmacology, have called such therapy into question. When psychological and emotional disturbances can be traced to faulty brain chemistry and corrected with a pill, the idea that sitting and talking can treat a problem such as clinical depression might seem outdated.
Robert DeRubeis of the University of Pennsylvania and his colleagues beg to differ, however. They have conducted the largest clinical trial ever designed to compare talk therapy with chemical antidepressants. The result, just published in Archives of General Psychiatry, is that talking works as well as pills do. Indeed, it works better, if you take into account the lower relapse rate.
The study looked at a relatively modern type of talk therapy, known as cognitive therapy, which tries to teach people how to change harmful thoughts and beliefs. Patients learn to recognize unrealistically negative thoughts when they occur, and are told how to replace them with more positive ones. It may sound too simplistic to work, but other studies have shown it can be used to treat anxiety, obsessive-compulsive disorder and eating disorders. Dr DeRubeis wondered just how effective it really was for depression.
In the study, 240 patients with moderate to severe depression were divided into three groups. One group was treated with cognitive therapy, a second with Paxil, an antidepressant drug, and members of the third group were given placebo pills. (Those in the second and third groups did not know whether their pills were placebos or not.) After 16 weeks of treatment, the results for those on cognitive therapy and drugs were identical. Some 58% had shown perceptible improvement. By contrast, only 25% of those on the placebo improved. That was encouraging. But the really surprising advantage of cognitive therapy is that it seems to keep working even after the therapy sessions are over. A year after treatments ended, only 31% of those who had received it had relapsed into their former state, while 76% of those who had been given antidepressants, and then been taken off them, had done so. Even patients who stayed on antidepressants for the intervening year did not do any better than those who had taken cognitive therapy and then quit.
If Dr DeRubeis's study can be replicated (an important “if” in a soft-edged discipline such as psychotherapy), it has implications for the way clinical depression should be approached in the future. One consideration, at least in America, where the study was done, is that many medical-insurance companies that are willing to pay for antidepressant drugs nevertheless refuse to pay for psychotherapy. A successful replication of the DeRubeis study ought to change that—not least because cost-benefit analysis shows that while cognitive therapy is more expensive than drug treatment to start with (since it involves extended one-to-one sessions with a highly paid specialist), it is cheaper in the long run because prescriptions do not have to be refilled indefinitely.
Which is not to say that cognitive therapy will suit everyone with depression. According to Dr DeRubeis, it is still likely that some patients will respond better to drugs than conversation. The next breakthrough might be a way of working out in advance who fits which treatment
For the first time, researchers have mapped what happens in the brain when a patient recovers from depression using cognitive behavioral therapy, a common form of psychological treatment aimed at breaking the bad habits of thought that bring people low.
The changes in the pattern of brain activity are quite different from those observed when patients recover with antidepressant drugs, and in some areas, even opposite, according to findings reported yesterday.
The mapping may provide a first step toward using brain scanning to determine which patients should receive antidepressants and which should receive psychological training, a decision that is now often based on trial and error, said Dr. Helen Mayberg, the study's senior author.
"This experiment lays the groundwork for looking for different markers that will help to optimize the treatment for a given individual; that's the really cool part," said Mayberg, a professor of psychiatry and neurology who conducted the study while at the University of Toronto but recently moved to Emory University in Atlanta.
Researchers also predict that the study could help raise the public standing of cognitive behavioral therapy, a series of lessons that trains patients to recognize their negative thoughts -- "I'm worthless" or "it's hopeless" -- and combat them with facts.
More highly directed and shorter-term than ordinary talk therapy, the psychological practice is already solidly established and is routinely paid for by insurance companies, but it tends to get much less attention than antidepressant drug therapy.
The scanning study's importance is "that you can see such a solid physical finding from a psychological treatment," said Dr. Bruce M. Cohen, president of McLean Hospital in Belmont. He was not involved in the research.
More broadly, Cohen added, the findings represent "one more step toward answering the question: What is happening in the brain when it's depressed? What happens when you change the way you think or take a drug and change the way you feel?"
Mayberg and colleagues used a brain-scanning technique called positron emission tomography to analyze for 15 to 20 sessions the brain metabolism of 14 subjects whose depression lifted considerably after cognitive behavioral therapy.
They found, among other things, that some areas in the cortex -- the outer rind of the brain associated with higher functions, such as thinking -- appeared to become less active, seemingly because patients learned to ruminate and worry less. With antidepressants, those regions became more active.
In essence, Mayberg said, depression stems from a malfunction not in a single spot in the brain, but in a network or circuit of brain connections. The study, published in this month's Archives of General Psychiatry, helps to contrast the two main approaches to fighting it.
"The network can reset itself via inputs working from a bottom-up perspective -- that, I think, is how drugs work -- while cognitive therapy works by influencing top-down inputs, turning down rumination and worry areas," said Dr. Zindel Segal, a University of Toronto psychiatry professor who worked on the study.
"Top-down" cognitive therapy begins with the cortex and its higher thinking functions; "bottom-up" drug therapy begins with the deeper, more primitive parts of the brain such as the brain stem and limbic system, which affect emotions and basic bodily functions. Each eventually affects the other through a complex network that remains little understood. An estimated one-fifth of Americans suffer from prolonged depression at some point.
Studies have shown that cognitive therapy is not only at least as effective as antidepressant drugs for some patients, but that many are less susceptible to relapse, said Aldo Pucci, president of the National Association of Cognitive-Behavioral Therapists.
Patients typically attend an average of 16 sessions, replete with homework, and come away with new skills that last much longer.
The therapy works, Segal said, by helping patients become aware of their negative "self-talk" and how it interacts with their mood. For example, he said, if patients have thoughts like "I'm unattractive," they are more likely to accept that thought as fact. Cognitive therapy helps them "develop a capacity to talk back to this depressive propaganda."
There are no national statistics available on how many people perform or undergo cognitive therapy, Pucci said, but his nine year old association already has 5,000 members.
"We maintain that for the overwhelming majority of people who are depressed, it's their thinking that causes their depression, not some biochemical problem," he said. The study, he said, "just supports what we've already been saying." Cognitive behavioral therapy "doesn't need the support, but certainly we'll take it," he said.
In fact, the study does not address the origins of depression, but it did suggest a basic aspect of antidepression therapy that surprised Mayberg: Drugs and cognitive therapy appear to operate on two different tracks, with no "final common pathway," she said.
Carey Goldberg can be reached at goldberg@globe.com.
Here is another article about CBT and depression
| Mental Health Resources |
| From Leonard
Holmes, Ph.D., Your Guide to Mental Health Resources. FREE Newsletter. Sign Up Now! |
Nov 21 2003
Medications or Psychotherapy for Depression?
That's a question that many people ask. The answer is complex. More antidepressants are prescribed by family practitioners than by psychiatrists. These medications are often the first treatment offered to people who are depressed. Managed care companies like this approach because antidepressant medications are less expensive than psychotherapy.
Numerous meta-analyses of research have come to similar conclusions about effectiveness. Cognitive-behavioral psychotherapy alone is at least as effective as antidepressant medication. Combined psychotherapy with medication are also more effective than medications, but some studies suggest that the combination is no more effective than psychotherapy alone. Studies also suggest that the relapse rate is higher among depressives treated with combined treatment than with just psychotherapy. Many studies have found a higher dropout rate among those receiving medication, either because of side effects or because the medication has not helped.
If the only tool you have is a hammer you tend to treat everything like a nail. As providers of health care and mental health care we tend to use the tools that we are trained to use. This can sometimes create problems. A saying attributed to different people (including Milton Erickson, M.D.) says it best: If the only tool you have is a hammer you tend to treat everything like a nail. It may be no coincidence that the authors of the studies cited here are psychologists. Psychologists are able to provide psychotherapy but not medications. It's also no coincidence that most primary care physicians prescribe antidepressant medications before they refer for counseling or psychotherapy. They have a prescription pad handy - but they do not have much time to spend talking with their patient. We tend to use the tools that we have.
Studies agree that both antidepressants and psychotherapy are effective treatments for depression. There is even agreement that a combination of the two may be more effective than either alone. It may well be that one treatment is likely to be more effective than the other for a particular person. The art and science of psychology and psychiatry are not yet refined enough to be able to predict which treatment will be more effective for a given person.
If you are depressed keep these principles in mind. The practitioner that you are seeing may have only certain tools available to him or her. Their recommendation for treatment may have more to do with their training than with any particular knowledge of your situation. The most important point may be that there are a variety of treatments that are effective for depression. It may not matter which treatment your doctor or therapist offers first. If it doesn't work, ask him or her about alternatives.
Read in-depth recommendations based on an extensive literature review...
References:
Link to ABCT article on CBT therapy